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Transthoracic echocardiography in Thai patients with acute ischemic stroke

Tapawas Piriyapong1, Pompatr A Dharmasaroja, Sombat Muengtaweepongsa

  • 1Department of lnternal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.

Journal of the Medical Association of Thailand = Chotmaihet Thangphaet
|August 23, 2013
PubMed

Insights

Electrocardiogram (ECG) is recommended for all acute ischemic stroke patients in Thailand. Transthoracic echocardiography (TTE) is advised for high-risk patients due to limited resources, though further study is needed for low-risk groups.

Area of Science:

  • Neurology
  • Cardiology
  • Medical Imaging

Background:

  • Transthoracic echocardiography (TTE) is a standard tool for identifying cardiac sources of emboli in Western stroke centers.
  • Resource limitations in Thailand restrict routine echocardiography for acute ischemic stroke patients.

Purpose of the Study:

  • To evaluate the necessity of cardiac investigations, particularly TTE, for Thai patients experiencing acute ischemic stroke.
  • To determine the yield of TTE in identifying cardioembolic sources in a resource-limited setting.

Main Methods:

  • A retrospective study of 207 patients with acute ischemic stroke or transient ischemic attack (TIA) who underwent TTE between August 2006 and November 2008.
  • Patients were stratified into low-risk and high-risk groups for cardioembolism.
  • Echocardiography results were analyzed for their impact on management decisions.

Main Results:

  • Abnormal TTE findings necessitating management changes occurred in 4% of low-risk and 18% of high-risk patients.
  • Electrocardiogram (ECG) alone prompted management changes in 17% of patients.
  • Atrial fibrillation, a common cause of cardioembolism, was identified in 17% of patients.

Conclusions:

  • Routine ECG is recommended for all ischemic stroke patients in Thailand.
  • TTE should be prioritized for patients at high risk of cardioembolism.
  • Further research is required to ascertain the benefits of TTE in low-risk ischemic stroke patients within resource-constrained healthcare systems.
Abstract

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